Tagged: Boston University
FOR IMMEDIATE RELEASE: August 15, 2013
Contact: Gina DiGravio, (617) 638-8480, email@example.com
(Boston) – According to a new study from the Slone Epidemiology Center (SEC) at Boston University, African-American women who reported more frequent experiences of racism had a greater likelihood of adult-onset asthma compared to women who reported less frequent experiences.
The study, which currently appears on-line in the journal Chest, was led by Patricia Coogan, DSc, senior epidemiologist at SEC and research professor of epidemiology at Boston University School of Public Health.
This study followed 38,142 African-American women, all of whom are participants in the Black Women’s Health Study (BWHS), between 1997 and 2011. They completed health questionnaires every two years. In 1997 and 2009 they provided information on their experiences of “everyday” racism, like poor service in stores or restaurants, and “lifetime” racism, which was discrimination encountered on the job, in housing and by police.
The results indicate that as experiences of everyday and lifetime racism increased, the incidence of adult-onset asthma also rose, up to a 45 percent increase in women in the highest compared to the lowest category of the racism measures. Furthermore, the incidence of asthma was increased even more in women who were in the highest category of everyday racism in both 1997 and 2009, and who may have had more consistent experiences of racism over time.
“This is the first prospective study to show an association between experiences of racism and adult-onset asthma,” said Coogan. “Racism is a significant stressor in the lives of African American women, and our results contribute to a growing body of evidence indicating that experiences of racism can have adverse effects on health.” The hypothesized mechanism linking experiences of racism to asthma incidence is stress and its physiological consequences, particularly effects on the immune system and the airways. “Given the high prevalence of both asthma and of experiences of racism in African Americans, the association is of public health importance,” she added.
BWHS is the largest follow-up study of the health of African American women in the United States. Led by researchers at the Slone Epidemiology Center, the BWHS has followed 59,000 African-American women through biennial questionnaires since 1995 and has led to a better understanding of numerous health conditions that disproportionately affect African-American women.
Funding for this study was provided by the National Institute of Health’s National Heart, Lung, and Blood Institute (grant award #HL107314) and the National Cancer Institute (grant award #CA058420).
BUSM /BMC Researcher Receives Grant to Examine Food Insecurity in Households with a Child with Special Healthcare Needs
For Immediate Release, June 12, 2013
Contact: Jenny Eriksen Leary, firstname.lastname@example.org, 617-638-6841
(Boston) – Ruth Rose-Jacobs, ScD, associate professor of pediatrics at Boston University School of Medicine (BUSM) and a research scientist at Boston Medical Center (BMC), has received funding for a two-year study to examine the association between the presence of young children with special healthcare needs in households and food insecurity. Rose-Jacobs, also a child development researcher with Children’s HealthWatch, is the principal investigator (PI) on this $249,984 grant awarded by the University of Kentucky’s Research Program on Childhood Hunger, which is funded by the United States Department of Agriculture (USDA) Food and Nutritional Service.
Children with special health care needs (SHCN) are children who have, or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and require health and related services of a type or amount beyond that required by children generally. The research project will examine the impact of having a young child with SHCN on child and/or household food insecurity in low-income households. Food insecurity is not being able to afford enough food for an active, healthy life for all household members. According to the National Survey of Children with Special Health Care Needs, approximately 15 percent of US children under the age of 17 have SHCN. Households with versus without a child with SHCN are more likely to live at or near the poverty level. The presence of a child with SHCN is associated with lower overall household adult employment due to the increased care needs of the child, which may be associated with family material hardships.
“We anticipate that households with a child with SHCN suffer disproportionately from food insecurity,” said Rose-Jacobs, who is one of three recipients of these two-year grants on food insecurity. “This study could have important implications for the expansion of food insecurity screening and inform practice in federal and state nutrition and non-nutrition assistance programs aimed at reducing food insecurity and other material hardships.
The study will take place at safety-net hospitals in Baltimore, Boston, Little Rock, Ark., Minneapolis and Philadelphia.
In 2011, approximately 25 percent of American households with children under 6 years of age were food insecure at some point during the year, according to data from the USDA’s Economic Research Service. According to Children’s HealthWatch (www.childrenshealthwatch.org), children from food insecure households, when compared to those from food secure households, are 90 percent more likely to be reported in fair or poor health and are two thirds more likely to be at risk for developmental delays.
To read more about the study, visit: http://www.ukcpr.org/CHTaskOrderRFP.aspx
For Immediate Release, May 1, 2013
Contact: Jenny Eriksen, 617-638-6841, email@example.com
(Boston) – A Boston University School of Medicine (BUSM) study shows a mind-body class elective for medical students helps increase their self-compassion and ability to manage thoughts and tasks more effectively. The study, published in Medical Education Online, also discusses how this innovative course may help medical students better manage stress and feel more empowered to use mind-body skills with their patients.
Allison Bond, MA, a third-year medical student at BUSM, served as the paper’s first author. The course was designed and taught by co-author Heather Mason, MA, founder and director of the Minded Institute.
“An effective career in medicine requires technical competence and expertise, but just as important is the ability to empathize and connect with others, including patients,” said Robert Saper, MD, MPH, director of integrative medicine at Boston Medical Center and associate professor of family medicine at BUSM. However, medical students experience tremendous demands from workload, stress and competition from other students to succeed, resulting in burnout and a decreased ability to connect with patients, according to studies.
“Research has shown that mindfulness meditation and yoga may increase psychological well-being, which is why we looked at how a course based on these principles could impact medical students,” said Bond.
The 11-week course, Embodied Health: Mind-Body Approaches to Well-Being, was open to first and second year medical students in good academic standing. It was developed to teach students about mind-body approaches, and the neuroscience behind the activities, that they might not otherwise learn in medical school but could use to help their patients achieve better overall health. Offered for the first time in Spring 2012, it met once weekly and included a 30 minute lecture about the neuroscience of yoga, relaxation and breathing exercises followed by a 60 minute yoga, deep breathing and mediation session. Each student was asked to practice the techniques (breathing, yoga, etc.) at least three times a week.
Participants filled out surveys before the course began and after it ended, and were asked about perceived empathy, perceived stress, self-regulation (ability to develop, implement and flexibly maintain planned behavior to achieve goals) and self-compassion. They also were asked to compose a one-page essay at the completion of the course to discuss if what they learned helped them personally and whether it influenced their ability to cope with stress or enhanced their sense of well-being.
Overall, responses indicate a statistically significant increase in self-regulation and self-compassion. There also was a decrease in perceived stress and an increase in empathy, although not statistically significant. The essays also indicate that the course helped many students:
- feel more aware of their bodies,
- feel a sense of community among their peers despite the competitive environment,
- build confidence in using mind-body skills with patients and
- better manage stress.
“Our study provides compelling evidence that mind-body approaches have benefits for medical students and could have a positive impact on their interaction with peers and patients,” said Bond.
For Immediate Release: April 25, 2013
Contact: Jenny Eriksen Leary, 617-638-6841, firstname.lastname@example.org
(Boston) – A study conducted by researchers at Boston University School of Medicine (BUSM) provides new evidence that longwave ultraviolet light (UVA) induces a protein that could result in premature skin aging. The findings demonstrate that aspects of photoaging, the process of skin aging by chronic exposure to ultraviolet radiation, could be linked to genetic factors that accelerate the aging process when induced by the environment.
The study, published in the Journal of Investigative Dermatology, was led by BUSM co-authors Thomas M. Ruenger MD, PhD, professor and vice chair of the department of dermatology, and Hirotaka Takeuchi, MS.
Photoaging is attributed to continuous exposure to UVA and shortwave ultraviolet light (UVB) rays over a long period of time and affects skin surfaces most often exposed to sunlight, including the face, ears, hands and neck. The UVA or UVB rays can be from the sun or from synthetic sources, such as tanning beds. Progerin is a protein that has been associated with both normal and abnormal aging. In Hutchinson Gilford Progeria syndrome, a genetic disorder characterized by a vast acceleration of aging of most organs, expression and accumulation of progerin is caused by a mutation in the Lamin A gene.
In this study, skin cells were cultured and exposed to UVB or UVA rays and then examined for expression and accumulation of progerin. The results showed that progerin is induced by ultraviolet light, specifically UVA rays, and that this induction is mediated by reactive oxygen species causing alternative splicing of the LaminA gene pre-mRNA.
“This, to our knowledge, is the first time that induction of progerin is described in response to an external agent,” said Ruenger, who also is professor of pathology and laboratory medicine at BUSM and a dermatologist at Boston Medical Center. “Our results reveal a novel mechanism by which UVA rays, which are often emitted from tanning beds, may play a role in the acceleration of photoaging of the skin.”
The researchers also note that some aspects of photoaging should be regarded as a process of damage-accelerated intrinsic aging and that intrinsic and extrinsic aging are interdependent.
Boston University Henry M. Goldman School of Dental Medicine Expands Elective Externship Program to Two University Sites in China
FOR IMMEDIATE RELEASE: April 8, 2013
Contact: Mary Becotte: 617-638-5147, email@example.com
Boston—Boston University Henry M. Goldman School of Dental Medicine (GSDM) will expand its Global Elective Externship program during the 2013–14 academic year to include an exchange program with two institutions in China: Shanghai Jiaotong University School of Stomatology (SJUSS), located in Shanghai, and the Fourth Military Medical University School of Stomatology (FMMUSS), located in Xi’an. GSDM students and residents will have the opportunity to do one- or two-week rotations in Oral and Maxillofacial Surgery under supervision by SJUSS and FMMUSS faculty. In return, GSDM will accept students and scholars from SJUSS and FMMUSS for clinical observation and/or research experience in various specialties at GSDM.
In his Strategy for a Global University, Boston University President Robert A. Brown states, “I believe that the future success and impact of Boston University as a great private research university will be interwoven with our presence as a truly global university in the 21st century.” Through these new exchange programs with FMMUSS and SJUSS, GSDM plans to extend its international dental externship program initiatives and to help fulfill the mission President Brown writes about. GSDM Dean Jeffrey W. Hutter said, “It is an honor and privilege to contribute to the global profile of this great University.”
The two-week externship training program at GSDM has already provided fourth-year DMD students at GSDM the chance to travel to Guatemala, Mexico, Haiti, Honduras, Nicaragua, Ukraine, and Jamaica for rotations. These rotations allow opportunities for the continued growth of the students’ clinical and critical thinking skills in treating diverse patient populations, along with the development of their cultural competencies. The externship locations in China will provide the added opportunity of observing and assisting in clinical practice in a hospital setting.
GSDM provides exemplary Advanced Specialty Education Programs in the recognized specialty areas of Dental Public Health, Endodontics, Oral & Maxillofacial Surgery, Orthodontics & Dentofacial Orthopedics, Pediatric Dentistry, Periodontics, and Prosthodontics. Students and residents from SJUSS and FMMUSS will benefit from observing world renowned leaders in dental specialties and patient treatment in technologically advanced settings, along with research being conducted in Biomaterials & Restorative Sciences, Health Policies & Health Services, Molecular & Cell Biology, and Oral Biology.
Robert J. Vinci, MD, Appointed Chief/Chair of Pediatrics at Boston Medical Center, Boston University School of Medicine
FOR IMMEDIATE RELEASE: April 2, 2013
Contact: Gina DiGravio, 617-638-8480, firstname.lastname@example.org
(Boston) – West Roxbury resident Robert J. Vinci, MD, has been appointed Chief of Pediatrics at Boston Medical Center (BMC) and the Joel and Barbara Alpert Professor and Chair of the Department of Pediatrics at BU School of Medicine (BUSM).
For the past 20 years, Vinci has served as Vice Chair and Clinical Chief of the Department, providing leadership for the significant expansion of pediatric clinical services. “We are fortunate to have someone of his skill level to lead the department. His commitment to the community and to our patients is highlighted by his central role in a number of initiatives at BMC,” said BMC President & CEO Kate Walsh. He co-founded the Kids Fund at BMC, which provides assistance for children’s most basic needs to give them a foundation for a healthy and bright future. He led the campaign to establish a window fall prevention program for children in Boston, called Kids Can’t Fly, which has led to a dramatic decrease in the number of window fall-related injuries. And in partnership with the Massachusetts Department of Public Health, Vinci provided leadership to establish the Massachusetts Emergency Medical Services Program for Children, which created training protocols and guidelines for children in the statewide EMS system.
Vinci received his medical degree from the College of Medicine and Dentistry-Rutgers Medical School, now known as the Robert Wood Johnson Medical School. He completed his pediatric residency at the former Boston City Hospital (now BMC), serving as chief resident, in 1983. He joined the Department of Pediatrics at Boston University School of Medicine in 1984 and two years later he established the Division of Pediatric Emergency Medicine at Boston City Hospital.
An innovative leader in medical residency education throughout his career, he founded the fellowship program in Pediatric Emergency Medicine BMC in 1988 and has directed Pediatric residency training at BMC since 1989. In 1996, Vinci, along with Frederick H. Lovejoy, MD, established the Boston Combined Residency Program in Pediatrics, one of the nation’s leading Pediatric residency programs. “He has championed research activities, global health training and flexible training opportunities for pediatric residents,” said BUSM Dean Karen Antman, MD.
Vinci has authored more than 60 peer-reviewed papers and book chapters on the topics of pediatric emergency medicine and pediatric education. He also has received numerous awards for teaching and mentoring, among them BUSM’s Leonard Tow Humanism in Medicine Award in 2010. He is a member of the National Board of Directors for the Association of Pediatric Program Directors, the American Academy of Pediatrics, the Academic Pediatric Association and the Academic Pediatric Society.
BMC Medical Center is one of the largest providers of pediatric services to low-income children in Boston and is known for its innovative approach to chronic illnesses, including asthma, sickle cell anemia, type 1 diabetes, HIV and failure to thrive.
EMBARGOED BY Chemistry & Biology through 12 p.m. ET, Thursday, March 21, 2013
Contact: Jenny Eriksen Leary, 617-638-6841, email@example.com
Could lead to the development of broad spectrum antivirals for deadly viruses
(Boston) – Researchers at Boston University School of Medicine (BUSM) have identified a new chemical class of compounds that have the potential to block genetically diverse viruses from replicating. The findings, published in Chemistry & Biology, could allow for the development of broad-spectrum antiviral medications to treat a number of viruses, including the highly pathogenic Ebola and Marburg viruses.
Claire Marie Filone, PhD, postdoctoral researcher at BUSM and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), is the paper’s first author and led this study under the leadership of John Connor, PhD, associate professor of microbiology at BUSM and the study’s corresponding author. John Snyder, PhD, professor of chemistry at Boston University (BU) and researchers from the Center for Chemical Methodology and Library Development at BU (CMLD-BU) were collaborators on this study.
Viruses are small disease-causing agents (pathogens) that replicate inside the cells of living organisms. A group of viruses known as nonsegmented, negative sense (NNS) ribonucleic acid (RNA) viruses cause common illnesses such as rabies, mumps and measles. These pathogens also cause more serious deadly diseases, including Ebola, Hendra and Nipah. Currently, there are no approved and effective treatments against these viruses, which, according to data from the Centers for Disease Control and Prevention, are associated with mortality rates up to 90 percent following infection.
“Identifying broad-spectrum antivirals is an important step in developing successful therapies against these and other viruses,” said Filone. The basic idea of a broad spectrum antiviral is similar to that of broad spectrum antibacterials in that they would allow one drug to serve as a common treatment for many different viral illnesses.
In this study, researchers identified a new chemical class of compounds that effectively blocked genetically diverse viruses from replicating by limiting RNA production by the virus in cell culture. These indoline alkaloid-type compounds inhibited a number of viruses from replicating, including Ebola.
“Because the production of viral RNA is the first step in successful replication, it appears that we have uncovered an Achilles heel to halt virus replication,” said Filone. “These compounds represent probes of a central virus function and a potential drug target for the development of effective broad-spectrum antivirals for a range of human pathogens.”
Research highlighted in this press release was funded in part by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) under grant award numbers RO1 AI1096159-01 and K22AI-064606 (PI: Connor).
EMBARGOED FOR RELEASE by PLOS ONE through 5 p.m. ET on March 20, 2013
Contact: Jenny Eriksen, 617-638-6841, firstname.lastname@example.org
(Boston) – Research from Boston University School of Medicine (BUSM) shows that improving vitamin D status by increasing its level in the blood could have a number of non-skeletal health benefits. The study, published online in PLOS ONE, reveals for the first time that improvement in the vitamin D status of healthy adults significantly impacts genes involved with a number of biologic pathways associated with cancer, cardiovascular disease (CVD), infectious diseases and autoimmune diseases. While previous studies have shown that vitamin D deficiency is associated with an increased risk for the aforementioned diseases, these results go a step further and provide direct evidence that improvement in vitamin D status plays a large role in improving immunity and lowering the risk for many diseases.
Vitamin D is unique in that it can be both ingested and synthesized by the body with sun exposure. It is then converted by both the liver and kidneys to a form that the body can use. An individuals’ level of vitamin D, or their vitamin D status, is determined by measuring the level of 25-hydroxyvitamin D in the blood. Vitamin D deficiency, which is defined as a status of less than 20 nanograms per milliliter (ng/mL) of 25-hydroxyvitamin D, can cause a number of health issues, including rickets and other musculoskeletal diseases. Recently, however, data suggests that vitamin D deficiency (<20 ng/mL) and vitamin D insufficiency (between 21-29 ng/mL) is linked to cancer, autoimmune diseases, infectious diseases, type 2 diabetes and cardiovascular disease.
The randomized, double-blind, single-site pilot trial involved eight healthy men and women with an average age of 27 who were vitamin D deficient or insufficient at the start of the trial. Three participants received 400 International Units (IUs) of vitamin D per day and five received 2,000 IUs per day for a two-month period. Samples of white blood cells (immune cells) were collected at the beginning of the two-month period and again at the end. A broad gene expression analysis was conducted on these samples and more than 22,500 genes were investigated to see if their activity increased or decreased as a result of the vitamin D intake.
At the end of the pilot, the group that received 2000 IUs achieved a vitamin D status of 34 ng/mL, which is considered sufficient, while the group that received 400 IUs achieved an insufficient status of 25 ng/mL.
The results of the gene expression analysis indicated statistically significant alterations in the activity of 291 genes. Further analysis showed that the biologic functions associated with the 291 genes are related to 160 biologic pathways linked to cancer, autoimmune diseases, infectious diseases and CVD. Examining gene response elements, or sequences of DNA bases that interact with vitamin D receptors to regulate gene expression, they also identified new genes related to vitamin D status. To ensure that their observations were accurate, the researchers looked at 12 genes whose level of expression does not change, and those genes remained stable throughout the trial period.
“This study reveals the molecular fingerprints that help explain the non-skeletal health benefits of vitamin D,” said Michael F. Holick, PhD, MD, professor of medicine, physiology and biophysics at BUSM and leading vitamin D expert who served as the study’s corresponding author. “While a larger study is necessary to confirm our observations, the data demonstrates that improving vitamin D status can have a dramatic effect on gene expression in our immune cells and may help explain the role of vitamin D in reducing the risk for CVD, cancer and other diseases.”
This research was supported by a pilot grant from the National Institutes of Health’s Clinical Translational Science Institute under grant award # UL-1-RR-25711.
To view the full article, visit http://dx.plos.org/10.1371/journal.pone.0058725.
For Immediate Release: March 18, 2013
Contact: Tom Testa, 617-353-7628, email@example.com
Signage, markings and reflector pilot program for BU’s Comm. Ave. campus stretch
(Boston) — In a continuing five-year effort to improve safety and calm traffic along its 1.5 mile-long main campus straddling Commonwealth Avenue, Boston University today announced with the City of Boston a series of measures to further protect cyclists and pedestrians, encourage bike use, and promote awareness of cyclists and pedestrians among motor-vehicle drivers. They will include new signage, enhanced bike-lane markings, and highway reflectors in the pavement.
“I am hopeful that these changes will help protect bicyclists and pedestrians traveling along this very busy stretch of Commonwealth Avenue,” said Boston University President Dr. Robert A. Brown. “I also am extremely grateful for the city’s continued support of bike-safety initiatives that safeguard all people who use the city streets that pass through our campus.”
The new measures stem from recommendations by a BU and City of Boston working group convened at the urging of President Brown and Mayor Menino after a series of bicycle collisions, including the death of a BU student in December. Working in coordination with the city’s Transportation Commissioner, Thomas J. Tinlin and Director of Bicycle Programs, Nicole Freedman, BU helped propose safety measures that the City will implement as a pilot on the stretch of Commonwealth Avenue between Kenmore Square and Packard’s Corner (Boston’s first location for bike lanes), with the potential to expand to other areas of the city with high bicycle traffic and lanes. They include:
- Posting of advisory/cautionary signs – new signs designating the stretch as a “high bicycle and pedestrian activity zone”; 25 mph speed limit signs; “yield to bicycles when turning right” signs; and “share the road” signs.
- Installation of enhanced bike-lane pavement markings – each bike-lane intersection crossing to be painted using non-skid, high-visibility green paint and the width of bike-lane edge markings will increase from four to six inches. White Bike Sharrow pavement markings within the green paint area will be added at busy intersections. In areas that have long crossings multiple Sharrows will be installed.
- Installation of highway reflectors –highway reflectors on the pavement along the outside edge of bike lanes between intersections, and more closely spaced in advance of each intersection crossing.
Boston Mayor Thomas M. Menino said, “The City of Boston has worked hard to ensure that cycling is a viable option for traveling on our local streets. In 2008, we installed the first four and a half miles of bicycle lanes, and today we offer more than 58 miles of on-street accommodations for cyclists. Wayfinding signs that guide cyclists to our more popular destinations have been posted, and in 2011 we launched Hubway that has provided 600,000 trips for those who rent the more than 600 curbside bicycles available through this program.”
He continued, “As a result of these efforts, bicycle commuting ridership increased 82% in Boston from 2007 to 2011, and ensuring safety for all of these cyclists is a top priority in the City. For this reason, I am very pleased to be partnering with Boston University on this Commonwealth Avenue safety initiative. I expect that this program will result in keeping BU’s cycling community safe on this busy roadway.”
The university also will host an event when students return from spring break to showcase the new measures. That will continue the ongoing bike-safety education and awareness efforts under way since 2008 which have included skills classes, commuter workshops, bike and pedestrian safety days, on-campus posters, widespread distribution of safety tips, and giveaways of some 15,000 bike-safety related items including helmets, flashlights, bicycle lights, and reflectors.
“Cycling is a terrific transportation option for students in Boston,” said Boston Transportation Department Commissioner Thomas J. Tinlin. “Like the MBTA, it is inexpensive and convenient, can get you anywhere that you need to go in the City, and doesn’t require an on-street parking space. BTD consistently encourages students to leave their cars at home when they are heading to Boston for the academic year, and this new bicycle safety initiative is yet another incentive for students to follow this advice.”
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For Immediate Release, March 18, 2013
Contact: Gina DiGravio, 617-638-8480, firstname.lastname@example.org
(Boston)–Boston Medical Center pediatricians Laura Johnson, MD, MPH, Jenny Radesky, MD, and Barry Zuckerman, MD, the Joel and Barbara Alpert Professor of Pediatrics at Boston University School of Medicine, have published a paper in the current issue of the journal Pediatrics that addresses how understanding the origins and goals of parenting behaviors can help pediatricians strengthen relationships with families, demonstrate cultural sensitivity, and more effectively offer guidance on the challenges of childrearing.
According to the paper, parenting goals and behavior are strongly influenced by cultural norms and expectations of adult behaviors that are valued by a particular society. They contrast “Western” cultures emphasizing individual autonomy achievement, independence, self-reliance, and self-assertiveness with many Asian, African, and Latino cultures that value interdependence: collective achievement, harmonious collaboration, and sharing. “Many parenting priorities, such as feeding practices, sleeping arrangements, and school and social success, fall somewhere along the spectrum from autonomy to interdependence and are likely affected by the parents’ cultural beliefs related to their own upbringing,” said Zuckerman. “This can result in some parenting behaviors conflicting with the beliefs of the pediatrician, as well as with policy statements from experts and professional societies based on culturally-bound empirical data, we aim to review a few examples of parenting differences that pediatricians might encounter,” he added.
The authors explain that every family is both a unique microcosm and a product of a larger cultural context. The three examples they highlight may be viewed through a cultural lens that promotes autonomy or interdependence. Importantly, these values are not dichotomous but rather exist along a spectrum co-existing sometimes changing over time.
In conclusion the authors state that by eliciting and understanding how cultural norms shape parenting behavior, including the role of extended family, and how they relate to a child’s growing autonomy and/or interdependence, pediatricians can help parents gain better insight into what they want for their child and how they address parenting challenges. This approach may encourage parents to more openly discuss their struggles with their child’s pediatrician and more readily consider their guidance and advice.